Healthcare Provider Details

I. General information

NPI: 1306824677
Provider Name (Legal Business Name): GLORIA CARR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MOBILE HWY
MONTGOMERY AL
36108-4027
US

IV. Provider business mailing address

1000 ADAMS AVE
MONTGOMERY AL
36104-4424
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-6670
  • Fax: 334-293-6676
Mailing address:
  • Phone: 334-263-2301
  • Fax: 334-263-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-038999
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: